Presentación de Nick Goodwin y Judith Smith en el proyecto de The King’s Fund y the Nuffield Trust: "Developing a National Strategy for the Promotion of Integrated Care"
Judith Smith and Chris Ham: Commissioning integrated care - what role for cli...The King's Fund
Dr Judith Smith, Head of Policy at the Nuffield Trust, and Professor Chris Ham, Chief Executive of The King’s Fund, share the findings of their recent research into how NHS commissioners have been commissioning better integrated services and care for people in local areas.
Slides from the workshop 'A modern vision of integrated care and support' led by Dr Martin McShane, Dr Damian Riley (NHS England) and David Pearson (ADASS) - NHS Medical Leaders Conference 2014. - See more at: http://www.icase.org.uk/pg/cv_content/content/view/98680#sthash.45Xs2o9r.dpuf
Chris Ham on making integrated care happen at scale and paceThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, highlights the 16 lessons needed to make a reality of integrated care, drawing on work by the Fund and others to provide examples of good practice.
Steve Laitner on integrated care - innovations in the UKThe King's Fund
Dr Steve Laitner, GP and Associate Medical Director of NHS East of England, discusses integrated care innovations in the UK with a focus on pathway hubs.
Judith Smith and Chris Ham: Commissioning integrated care - what role for cli...The King's Fund
Dr Judith Smith, Head of Policy at the Nuffield Trust, and Professor Chris Ham, Chief Executive of The King’s Fund, share the findings of their recent research into how NHS commissioners have been commissioning better integrated services and care for people in local areas.
Slides from the workshop 'A modern vision of integrated care and support' led by Dr Martin McShane, Dr Damian Riley (NHS England) and David Pearson (ADASS) - NHS Medical Leaders Conference 2014. - See more at: http://www.icase.org.uk/pg/cv_content/content/view/98680#sthash.45Xs2o9r.dpuf
Chris Ham on making integrated care happen at scale and paceThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, highlights the 16 lessons needed to make a reality of integrated care, drawing on work by the Fund and others to provide examples of good practice.
Steve Laitner on integrated care - innovations in the UKThe King's Fund
Dr Steve Laitner, GP and Associate Medical Director of NHS East of England, discusses integrated care innovations in the UK with a focus on pathway hubs.
The route to success in end of life care - achieving quality in domiciliary care
26 February 2011 - National End of Life Care Programme
This guide has been developed by the National End of Life Care Programme in conjunction with a range of organisations working with people receiving domiciliary services at home, as part of its route to success series.
It is intended to be a practical tool offering advice on what domiciliary organisations and their staff can do as well as how and when to access specialist help.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
Integrated Care in Seniors Housing that Meets the Triple AimCindy Longfellow
New research on Juniper Communities’ Connect4Life model, completed by Anne Tumlinson Innovations, promises better outcomes for frail seniors and the potential for Medicare cost savings.
The data demonstrate the promise of integrating health and senior housing to manage population health.
Integrated Care in Seniors Housing that Meets the Triple AimCindy Longfellow
New research on Juniper Communities’ Connect4Life model, completed by Anne Tumlinson Innovations, promises better outcomes for frail seniors and the potential for Medicare cost savings.
The data demonstrate the promise of integrating health and senior housing to manage population health.
Alzheimer Europe talk 2015 Dr Shibley Rahmanshibley
These are the slides for the presentation I will give this year at the Alzheimer Europe conference in Ljubljana in Slovenia. It's survey based research on the importance of clinical nursing specialists in dementia.
Nick Goodwin - Bringing integrated care to lifeAge UK
Dr Nick Goodwin, Senior Fellow, The King's Fund - presentation from Age UK's For Later Life conference, 25th April.
For more information: www.ageuk.org.uk/forlaterlife
La voz de los pacientes en los proyectos de integracion de servicios del nhs ...Societat Gestió Sanitària
Ponencia a cargo del director de politicas y colaboraciones del National Voices en el National Health Service inglés, en el marco de la VI Jornada Right Care sobre Modelos avanzados en integración de servicios sociales y sanitarios, organizada por la Societat Catalana de Gestió Sanitària el 24 de mayo de 2019.
The route to success in end of life care - achieving quality in domiciliary care
26 February 2011 - National End of Life Care Programme
This guide has been developed by the National End of Life Care Programme in conjunction with a range of organisations working with people receiving domiciliary services at home, as part of its route to success series.
It is intended to be a practical tool offering advice on what domiciliary organisations and their staff can do as well as how and when to access specialist help.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
Integrated Care in Seniors Housing that Meets the Triple AimCindy Longfellow
New research on Juniper Communities’ Connect4Life model, completed by Anne Tumlinson Innovations, promises better outcomes for frail seniors and the potential for Medicare cost savings.
The data demonstrate the promise of integrating health and senior housing to manage population health.
Integrated Care in Seniors Housing that Meets the Triple AimCindy Longfellow
New research on Juniper Communities’ Connect4Life model, completed by Anne Tumlinson Innovations, promises better outcomes for frail seniors and the potential for Medicare cost savings.
The data demonstrate the promise of integrating health and senior housing to manage population health.
Alzheimer Europe talk 2015 Dr Shibley Rahmanshibley
These are the slides for the presentation I will give this year at the Alzheimer Europe conference in Ljubljana in Slovenia. It's survey based research on the importance of clinical nursing specialists in dementia.
Nick Goodwin - Bringing integrated care to lifeAge UK
Dr Nick Goodwin, Senior Fellow, The King's Fund - presentation from Age UK's For Later Life conference, 25th April.
For more information: www.ageuk.org.uk/forlaterlife
La voz de los pacientes en los proyectos de integracion de servicios del nhs ...Societat Gestió Sanitària
Ponencia a cargo del director de politicas y colaboraciones del National Voices en el National Health Service inglés, en el marco de la VI Jornada Right Care sobre Modelos avanzados en integración de servicios sociales y sanitarios, organizada por la Societat Catalana de Gestió Sanitària el 24 de mayo de 2019.
Integrando los servicios sociales y sanitarios. Una vision desde la internati...Societat Gestió Sanitària
Ponencia a cargo del médico geriatra Marco Inzitari, director de Atención Intermedia, Investigación y Docencia del Parc Sanitari Pere Virgili, en el marco de la VI Jornada Right Care sobre Modelos avanzados en integración de servicios sociales y sanitarios, organizada por la Societat Catalana de Gestió Sanitària el 24 de mayo de 2019.
Long Term Care FacilitiesLong term care facilities have gained .docxsmile790243
Long Term Care Facilities
Long term care facilities have gained popularity nowadays in the health care department. The assignment will focus two long term care facilities one facility is from nursing facility, and the other one is the adult day care. One has the responsibility of managing and administering either of the two facilities. The new managers appointed needs to be oriented and familiarized on the management of the long term care facility. The assignment provides a description of the different multidisciplinary teams, and departments included in the facilities. It also provides those who are comprised in the target population of the various programs in the care facilities. The human resource and major staffing issues faced in the home nursing and adult day care. The assignment will also focus on the significance trends likely to affect the operation of the different programs in the long term care facilities and how to overcome them. Finally, the integration and cooperation forms in the long term care facilities are outlined in the assignment. The financing, management nature and quality issues affecting cooperation and integration in the facilities are also discussed in the assignment.
Multidisciplinary teams are very essential in nursing facility. The main objective of the multidisciplinary teams is to ensure that there is improved outcome on the patients’ health status. The multidisciplinary disciplinary teams involve the staffs in the nursing facility. There are different levels of multidisciplinary teams in the nursing facilities. The levels can be grouped as follows; nurses, technicians, anesthesiologists, and attending physicians (Medicaid, 2017). The teams work together through proper communication in different levels to ensure improved outcome of the patient. The various multidisciplinary teams should be trained to work collaboratively.
The main aim of the multidisciplinary teams is to ensure that there is improved outcome on the patient’s health status. The multidisciplinary disciplinary teams involve the staffs in the adult day care. Adult day care involves taking care of an individual in all round manner. That is nutritional, health, and the daily living needs. There are different teams involved in each activity in the adult day care facility. There are nutritionist, health specialists, fitness advisor, and living advisor. For health specialists, there are different levels of multidisciplinary levels can be grouped as follows; nurses, technicians, anesthesiologists, and attending physicians (Epstein, 2014). The teams work together through proper communication in different levels to ensure improved outcome of the patient. The various multidisciplinary teams should be trained to work collaboratively. The attending doctor performs regular check up on the individuals to find out if there are any signs of disease or peculiar body behavior. After the check up, the attending physician communicates the results to the other memb ...
Developing non-clinical approaches and are pathways to fundamental socioeconomic issues that are presented in the primary care and secondary care settings
Nick Goodwin: making a success of care co-ordinationThe King's Fund
Nick Goodwin, Chief Executive at the International Foundation for Integrated Care, looks at how care could be better co-ordinated around people with complex needs, and the challenges around delivering joined-up care.
Rosie Jean Louis Discussion 7COLLAPSETop of FormCommunity N.docxhealdkathaleen
Rosie Jean Louis: Discussion 7
COLLAPSE
Top of Form
Community Nursing Practice Model
The prevalence of illness among poor urban and rural populations increase the demand for critical care services. However, there is a shortage for physicians who can take up responsibilities in the community health sector. Among the efforts in place to strengthen the human resource is the growing interest to have nurses in advance practices participate inpatient care at the community health level. By applying the community, nursing practice model advanced practice nurses are better prepared to deliver care and outcomes to patients in poor communities.
The Community Nursing Practice Model
The community nursing model plays an essential role in ensuring that less privileged communities can access better healthcare by providing a framework for community nurses to focus on entire populations that have similar health concerns or characteristics. For example, a society where there are reproductive health issues, nurses applying this model in such a community will be able to know what the needs of the community are as far as reproductive health is concerned (Maclaine, 2014).
The model considers all levels of prevention, which include primary prevention whereby the advanced practice nurses promote health and protect against threats to health in the community. For example, carrying out awareness in the community on sexually transmitted diseases and distributing latex condoms in the community (Maclaine, 2014). Another level of prevention is secondary prevention, which involves the community nurses’ practitioners detecting and treating problems at the early stage of detection so that the health problem does not cause serious problems or affect others. The last level of prevention involves the community nurse practitioner preventing existing problems from getting worse.
The MSN Essential
Clinical prevention and population health are one of the MSN essential that is relevant to the community nursing practice. The underlying notion of this MSN essential is recognizing that masters prepared nurse applies and integrates a good organizational, patient-centered and culturally appropriate idea in planning to deliver and managing of clinical prevention and community care services to individuals and families (AACN, 2011). Under this essential, it is well elaborated that a master’s degree level nurse should be able to synthesize broad social determinants of health and data from epidemiology to design and deliver clinical interventions to the communities in need while using relevant strategies.
In summary,the model has transcended values of respect, care, and wellness, which are essential in primary health care. The CNP and MSN essential provide a framework for nurses who want to practice in the community health sector and especially for advanced care nurses. The model depicts community health nursing practitioners as an essential part of an interdisciplinary team that includes phys ...
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
Patient care collectives facilitate this empowerment by fostering trust, transparency, and mutual respect between patients and healthcare providers. By engaging patients as partners in their care journey, these collectives not only enhance health outcomes but also cultivate a sense of agency and autonomy among individuals.
Trillium II /Focus workshop at Informatics for Health2017: Manchester, April 24-27, 2017
Frailty is an age-related state of vulnerability to the risk of adverse health out-comes after a stressor event. The condition predisposes individuals to progressive decline in different functional domains, leading to falls and fractures, disability and dependency on others, hospitalization, institutional placement and ultimately death. We discuss drivers, challenges and opportunities for healthcare information standards related to frailty in old age in an effort to launch a call for coordinated action across research, policy, and academia. Key issues are selected as the back-drop for this discussion: EHR, patient summaries and frailty in a context of coor-dinated care enabled by health IT standards.
Presentation 2 of 5 by Maria Magdalena Bujnowska-Fedak
Wroclaw Medical University, Poland
Similar to The Evidence Base for Integrated Care (20)
Ponencia en el congreso SADECA (Sociedad Andaluza de Calidad Asistencial) sobre nuevos modelos de aprendizaje, cursos virtuales y congresos online. Fecha: 19/11/2020
Material de la clase realizada en el Master Europubhealth de la EASP (Escuela Andaluza de Salud Pública) sobre marketing social, comportamiento y covid-19.
07/05/2020
Ponencia del Simposio de Innovación organizado por la Sociedad Murciana de Calidad Asistencial (SOMUCA) celebrado en Murcia el 16/05/2018.
Vídeo y audio de la charla:
https://twitter.com/carlosplcht/status/996680614630707200
Presentación de la Jornada "Capital humano y gestión del talento en sanidad" organizada por la Unión Murciana de Hospitales y celebrada en Murcia el 05/04/2016.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
The Evidence Base for Integrated Care
1. The King’s Fund and the Nuffield Trust
Developing a National Strategy for the Promotion of Integrated Care
The Evidence Base for
Integrated Care
Nick Goodwin and Judith Smith
2. Key questions
What do we mean by integrated care?
What problem does integrated care seek to address?
– Who is integrated care for?
Examples of integrated care
Why is integrated care such a challenge?
– Key barriers to developing integrated care
– Competition, choice and integrated care
What can be done to support integrated care?
– Applying ‘tools’ to support integrated care
– Targeting and managing population groups
– Aligning system incentives
What does this experience tell us about adopting and
mainstreaming integrated care ‘at scale’?
– The successful components of an integrated care strategy
How can success be defined and measured?
4. A new idea?
The idea is not new – concern about lack of integrated care
dates back to before the start of the NHS
This concern has been about fractures in systems and delivery
that allow individuals to ‘fall through the gaps’ in care – eg,
primary/secondary care, health/social care,
mental/physical health care
Approaches that seek to address fragmentation of care are
common across many health systems, and the need to do
so is increasing as more people live longer and with
complex co-morbidities
5. Integrated care is centred around the
needs of users
Integrated care means different things to different people
‘The patient’s perspective is at the heart of any discussion
about integrated care. Achieving integrated care requires
those involved with planning and providing services to
impose the patient’s perspective as the organising
principle of service deliver’ (Shaw et al 2011, after Lloyd and
Wait 2005)
6. Integration and Integrated Care
Integration is the combination of processes, methods and
tools that facilitate integrated care.
Integrated care results when the culmination of these
processes directly benefits communities, patients or service
users – it is by definition ‘patient-centred’ and ‘population-
oriented’
Integrated care may be judged successful if it contributes to
better care experiences; improved care outcomes;
delivered more cost effectively
‘Without integration at various levels [of health systems], all aspects of
health care performance can suffer. Patients get lost, needed services fail
to be delivered, or are delayed, quality and patient satisfaction decline,
and the potential for cost-effectiveness diminishes.’
(Kodner and Spreeuwenbur, 2002, p2)
7. Key forms of integrated care
Integrated care between health services, social services
and other care providers (horizontal integration)
Integrated care across primary, community, hospital and
tertiary care services (vertical integration)
Integrated care within one sector (eg, within mental health
services through multi-professional teams or networks)
Integrated care between preventive and curative services
Integrated care between providers and patients to support
shared decision-making and self-management
Integrated care between public health, population-based
and patient-centred approaches to health care
– This is integrated care at its most ambitious since it focuses on the
multiple needs of whole populations, not just to care groups or
diseases
Source: adapted from International Journal of Integrated Care
11. Matching client needs with approaches
to integrated care
The intensity with which organisations and services need to integrate with
each other depends on the needs of the client. Full (organisational)
integration works best when aimed at people with severe, complex and long-
term needs. (Leutz 1999)
Client needs Linkage Co-ordination Full integration
SEVERITY Mild to moderate Moderate to severe Moderate to severe
STABILITY Stable Stable Unstable
DURATION Short to long-term Short to long-term Long-term to terminal
URGENCY Routine/non-urgent Mostly routine Frequently urgent
SCOPE OF NEED Narrow to moderate Moderate to broad Broad
SELF-DIRECTION Self-directed Moderate self-directed Weak self-directed
12. Many approaches to integration
Integration can be undertaken between organisations, or between different
clinical or service departments within and between organisations
Integration may can focus on joining up primary, community and hospital
services (‘vertical’ integration) or involve multi-disciplinary teamwork
between health and social care professionals (‘horizontal’ integration)
Integration may be ‘real’ (ie, into a single new organisation) or ‘virtual’ (ie, a
network of separate providers, often linked contractually).
Integration may involve providers collaborating, but it may also entail
integration between commissioners, as when budgets are pooled.
Integration can also bring together responsibility for commissioning and
provision. When this happens, clinicians and managers are able to use
budgets either to provide more services directly or to commission these
services from others: so-called ‘make or buy’ decisions.
(Curry and Ham 2010)
13. Integration without care co-ordination
cannot lead to integrated care
Effective care co-ordination can be achieved without the need for the formal
(‘real’) integration of organisations. Within single providers, integrated care
can often be weak unless internal silos have been addressed. Clinical and
service integration matters most.
15. Who is integrated care for?
Integrated care is an approach for any individuals where
gaps in care, or poor care co-ordination, leads to an
adverse impact on care experiences and care outcomes.
Integrated care is best suited to frail older people, to those
living with long-term chronic and mental health illnesses,
and to those with medically complex needs or requiring
urgent care.
Integrated care is most effective when it is population-
based and takes into account the holistic needs of patients.
Disease-based approaches ultimately lead to new silos of
care.
16. The Mrs Smith test...
Many people with mental, physical and/or
medical conditions are at risk of long hospital
stays and/or commitment to long-term care in a
nursing home.
Mrs Smith is a fictitious women in her 80s with a
range of long-term health and social care
problems for which she needs care and support.
Mrs Smith encounters daily difficulties and
frustrations in navigating the health and social
care system.
Problems include her many separate
assessments, having to repeat her story to many
people, delays in care due to the poor
transmission of information, and bewilderment at
the sheer complexity of the system.
18. … to a co-ordinated service that
meets her needs
19. Examples of Integrated Care
To illustrate who integrated care is for, the following slides look at some key
care groups to whom integrated care is most suitable. Examples of integrated
care from around the UK are provided to illustrate how integrated care has
been achieved.
20. Integrated care for frail older people
Torbay Care Trust North Somerset
Integrated health and social care As one of 29 sites involved in the
teams, using pooled budgets and Department of Health Partnership for
serving localities of around 30,000 Older People Project (POPP), four fully
people, work alongside GPs to provide a integrated and co-located multi-
range of intermediate care services. By disciplinary teams provide case
supporting hospital discharge, older management and self-care support to
people have been helped to live older people. The aim is to prevent
independently in the community. Health complications in diseases and
and social care co-ordinators help to deterioration in social circumstances.
harness the joint contributions of team
members. Based around clusters of GP practices,
the service brings together community
The results include reduced use of health and social care workers,
hospital beds, low rates of emergency community nurses, adult social care
admissions for those over 65, and services, and mental health
minimal delayed transfers of care. professionals.
(Thistlethwaite 2011) (Windle et al 2010)
21. Integrated care for people with a chronic disease
Diabetes care in Bolton Rheumatology care in Oldham
In Bolton, a community-based diabetes The Pennine Musculoskeletal (MSK)
network supports the management of Partnership provides an integrated multi-
diabetic patients with severe and disciplinary service in rheumatology,
complex needs. Care is based within a orthopaedics, and chronic pain. Led by
Diabetes Centre that hosts a multi- consultant rheumatologists, the team
disciplinary specialist care team, but this employs a clinical assessment nurse,
team also reaches in to the local hospital specialist rheumatology nurses,
for inpatient care, and out into general physiotherapists, occupational therapists,
practices to support consultations. orthopaedic consultants, liaison
Patients and staff have reported high psychiatrists, and podiatric surgeons.
satisfaction with the community-based Pennine MSK is able to triage patients
service and, in 2005/6, Bolton achieved within 24 hours, has low waiting times for
the lowest number of hospital bed days assessment (over 80 per cent now within
per person with diabetes in the Greater one to three weeks), and most patients
Manchester area . are seen and discharged from the service
(NHS Alliance 2007) within seven weeks.
(Pennine Partnership MSK Ltd 2011)
22. Integrated care for people living with multiple
long-term health and social care needs
Hereford Wales
An integrated care organisation Chronic Care Demonstrators
In Hereford, an integrated care In Wales, three Chronic Care
organisation based on eight health and Management (CCM) Demonstrators in
social care neighbourhood teams is in Carmarthenshire, Cardiff and Gwynedd
development to support the personal Local Health Boards have pioneered co-
health, well being and independence of ordinated care for people with multiple
frail older people and those with chronic chronic illness. By employing a ‘shared
illnesses such as diabetes, stroke and care’ model of working between
lower back pain. primary, community, secondary and
social care the three demonstrators
Early successes include lower bed were able to reduce the total number of
utilisation and reductions in delayed bed days for emergency admissions for
discharges from hospitals. chronic illness by 27%, 26% and
(Woodford 2011)
16.5% between 2007-2009. This
represented an overall cost-reduction of
£2,224,201 .
(NHS Wales 2010)
23. Integrated care for people with urgent
and/or medically complex problems
Stroke care in London Bolton’s urgent care
dashboard
Implementation of a pan-London stroke NHS Bolton’s GP urgent care dashboard
care pathway and the development of provides an analytical tool that tracks
eight hyper-acute stroke units has attendance patterns in real-time from
improved access and reduced length of multiple sources including A&E, walk-in
stay in hospitals. 85 per cent of high- centres and out-of-hours services.
risk patients who have had a transient
ischaemic attack are treated within 24 The approach helps clinicians mobilise
hours, compared with a national more appropriate care and support to
average of 56 per cent, and 84 per cent ensure patients access the most
of patients spend at least 90 per cent of appropriate urgent care services. In
their time in a dedicated stroke unit, 2009, A&E admissions fell 3% against a
compared to a national average of 68 regional increase of 9%. Unscheduled
per cent. hospital admissions fell 4%.
(Ham et al 2011).
(Imison et al 2011)
24. Integrated care for those at the end-of-life
Cambridgeshire ICO Pilot Liverpool Care Pathway
One of the Department of Health’s The Liverpool Care Pathway seeks to
integrated care organisation pilots, it integrate the variety of care inputs that
has sought to establish a model of an individual is likely to experience in
integrated primary, secondary and the final days and hours of life. It helps
community health services delivering guide care professionals in continuing
end-of-life care across East and South medical treatment, discontinuing
Cambridgeshire and Cambridge City. treatment, and initiating comfort
measures.
The key aims of the pilot have been to
enable people to die in their place of The pathway has been used in
choice, with end-of-life care tools being hospitals, hospices, care homes, and
used across partner organisations. patients’ own homes as well as in other
community settings. For example, it
was used by United Lincolnshire
Hospital Trust as a tool for managing
patients nearing the end of their lives in
the acute setting.
26. Integrated care does not evolve
naturally – it needs to be nurtured
Integrated care does not appear to evolve as a natural
response to emerging care needs in any system of care
whether this be planned or market-driven.
There is no evidence, therefore, that clinical and service
integration in England is any more or any less likely to
succeed than in countries without a purchaser-provider split
such as Scotland or New Zealand.
Achieving the benefits of integrated care requires strong
system leadership, professional commitment, and good
management.
Systemic barriers to integrated care must be addressed if
integrated care is to become a reality.
(Ham et al 2011)
27. Key organisational and management barriers
Bringing together primary medical services and community health
providers around the needs of individual patients
Addressing an unsustainable acute sector
Developing capacity in primary care to take on new services
Managing demand and developing new care models
Establishing effective clinical leadership for change
Overcoming professional tribalism and turf wars
Addressing the lack of good data and IT to drive integration, eg,
in targeting the right people to receive it
Involving the public and creating a narrative about new models of
care
Establishing new forms of organisation and governance (where
these are needed)
Learning from elsewhere in the UK and overseas
(Ham and Smith, 2010; Goodwin 2011)
28. Key challenges for health and social
care integration
Scale and pace of change could
undermine local achievements in
integrated care
Clinical commissioners
commitment to integrated care
Strength of health and wellbeing
boards to promote integration and
exert influence/leadership
Whether financial pressures will
promote the shared planning and
use of resources
Whether three separate outcomes
frameworks (right) will offer
sufficient incentives for aligning
services around the needs of
people rather than organisations.
(Humphries and Curry 2011)
29. Key policy barriers
Payment policy that encourages acute providers to expand activity
within hospitals (rather than across the care continuum)
Payment policy that is about episodes of care in a particular
institution (rather than payment to incentivise integration, such as
payments for care pathways and other forms of payment
bundling)
Under-developed commissioning that often lacks real clinical
engagement and leadership
Policy on choice and competition
Regulation that focuses on episodic or single-organisational care
Lack of political will to support changes to local care, including
conversion or closure of hospitals
(Ham and Smith 2010; Ham et al 2011)
30. Competition, choice and integrated care
Reform policies to increase choice and competition in the NHS
may impede the development of integrated care
There will be a need for a nuanced approach by Monitor as it
develops its approach to regulating for both competition and
collaboration
Competition could be promoted within integrated systems, and
choice could be made between them
Clinical commissioning groups will need support and advice about
how to commission for integrated care, share risks and rewards,
etc.
NHS Commissioning Board and Monitor will need a new payment
policy and adopt new contract currencies to incentivise integrated
care
There is a need for experimentation, innovation, and permission
for these to take place as reforms progress
(Hawkins 2011; Ham et al 2011)
32. Investing and applying the tools of
integrated care
There are many different ways in which professionals and providers can work
directly with communities, patients/clients to support integrated care. These
‘tools’ of integrated care focus on the ‘how’ of clinical and service integration
Examples of tools for clinical or Examples of tools for service
professional integration: integration:
• Case finding and use of risk- • Care co-ordination
stratification • Case management
• Standardised diagnostic and • Disease management
eligibility criteria • Centralised information, referral and
• Comprehensive joint assessments intake
• Joint care planning • Multi-disciplinary teamwork
• Single or shared clinical records • Inter-professional networks
• Decision support tools such as care • Shared accountability for care
guidelines and protocols • Co-location of services
• Technologies that support • Discharge/transfer agreements
continuous and remote patient
monitoring • Personal health budgets
• Peer review
33. Investing and applying the tools of
integrated care – case example
The North Lanarkshire Health and Key tools for clinical integration used
Care Partnership brings together in North Lanarkshire included:
the work of North Lanarkshire • multi-professional team-working
Council and NHS Lanarkshire to between health and social care
deliver better integrated services to • organisational development work
four care groups: older people, and to develop shared goals and
those with disabilities, addictions and values
mental health problems.
• the creation of shared outcome
measures
Clinical integration has focused on • care co-ordination targeted at the
aligning the goals and working highest risk individuals with the
practices of health and social care most complex problems
professionals in order to deliver
better care co-ordination and • involvement of community teams
improve care outcomes. and organisations in ongoing care
and support
(Rosen et al 2011)
34. Targeting and managing populations
Strategies to apply integrated care Examples include:
often focus on particular groups of • health and social care teams
patients or populations, whether providing co-ordinated care to
classified by age, condition, or some frail older people, such as in
other characteristic such as public Torbay (above)
health need. Frail older people, • ‘virtual wards’ providing home-
and/or those with long-term based case management to high-
conditions, are typical targets. risk individuals and led by
community matrons, such as in
‘Population management’ refers to Croydon and Wandsworth
the strategic activity of pro-actively • disease management
identifying individuals in these programmes focusing on people
groups, usually those at risk of a with specific conditions such as
deterioration in their health or at risk diabetes, heart failure or COPD
of institutionalisation. Where • managed networks that
interventions are appropriately strengthen co-ordination of care
targeted, there is evidence that care for people with specific health and
quality can be improved. social care needs (eg, learning
disabilities and neurological
(Goodwin et al 2010)
disorders)
35. Case finding: predicting those at risk
The accurate identification of individuals appropriate for an integrated care
intervention is crucial to the success of any population management
programme. Without a reliable method of stratifying people into risk groups
it is likely that care will be targeted at those people who either do not need
it, and potentially miss those who do. Predictive risk tools are increasingly
being employed in the NHS, and there is potential to extend the approach to
social care. As well as its role in case finding, the approach can be used to
allocate resources across a population, and for performance management
and evaluation purposes.
(Nuffield Trust 2011)
36. Aligning system incentives
At a ‘macro’ level, integrated delivery systems bring together
providers, potentially with commissioners, to take on
responsibility for the full spectrum of services to the
populations they serve.
These organisations seek to align system incentives –
regulatory, accountability, financial – and promote a common
set of values that help to create a platform through which
integrated care ‘at scale’ can flourish across whole
populations.
They are sometimes referred to as ‘accountable care
organisations’ where providers and their employees take on
some of the financial risk in managing health care budgets
alongside responsibility for care quality and care outcomes to
the populations which they serve.
37. Integrated care at the macro-level
Example 1:
Kaiser Permanente, a virtually integrated system serving
8.7 million people in eight regions. Health plans, hospitals
and medical groups in each region are distinct organisations
linked through contracts. A key feature of the Kaiser
Permanente model is the emphasis placed on keeping
members healthy and achieving close co-ordination of care
between providers through the use of electronic medical
records and teamworking.
Curry and Ham (2010)
38. Integrated care at the macro-level
Example 2:
Veterans Health Administration employs medical staff
and owns and runs hospitals to manage the full range of
care to veterans within a budget allocated by the federal
government. It operates through 21 regionally based
integrated service networks that receive capitated funding.
There is rigorous performance management centred on key
markers of clinical quality and outcomes that incentivise
home-based care and care co-ordination for people with
chronic illness.
Curry and Ham (2010)
39. Integrated care at the macro-level
Example 3:
Integrated Medical Groups in the US bring together
primary, secondary and specialist physicians to take on a
budget with which to provide and commission all or some
services required by the populations they serve. By
integrating physician services around the patient, and using
key tools such as electronic medical records and peer
review processes, studies have shown that inappropriate
admissions to hospitals can be reduced and lengths of stay
cut.
Curry and Ham (2010)
40. Integrated care at the macro-level
Example 4:
San Marino, a republic of 30,000 people on the Italian
peninsula, integrates health and social care at an
organisational and professional level using a single budget.
Care professionals work in multi-disciplinary teams and
take both individual and group accountability for service
delivery (such as for joint assessment, planning, care
management, and care outcomes). Investment is made in
the services and skills required to support integrated care,
including the fostering of an organisational culture to
overcome individual professional interests. San Marino has
been rated as one of the best care systems in the world by
the WHO due to its combination of high life expectancy, low
per capita spend, and comprehensive coverage.
Pasini (2011)
41. Aligning incentives requires integrative processes as the
‘glue’ between teams and organisations
Source: Integration in Action . Rosen et al 2011
42. The importance of leadership
Professional leaders play a central role in the success of integrated care.
Effective leaders are usually characterised by their sustained long-term
commitment, enthusiasm and involvement to integrated care locally, and the
trust and respect given by their peers that has built up over time
Leaders need the skills and strategies necessary to understand, influence and
lead the local agenda in the design, commissioning and delivery of integrated
care. The range of roles includes:
– identifying and demonstrating the core values and purpose that underpin
approaches to integration
– building a common vision and goals between care partners
– engaging professionals, developing good relationships, and building
commitment, understanding and a shared culture
– maintaining a clear vision communicating this clearly to staff and users
– driving quality improvements, for example through benchmarking
performance and peer-review
Leaders in the NHS, local government and the third sector must take the
initiative and promote integrated care, rather than adopt a fortress mentality
focusing on the survival of their organisations
Leaders need to work together across a health community to achieve financial
and service targets. (Ham et al 2011; Rosen et al 2011)
43. Key issues in creating an enabling
policy environment for integrated care
Have a regulatory framework that encourages
integration and integrated care
Have a financial framework that encourages integrated
care
Provide support to innovative approaches to
commissioning integrated services
Apply national outcome measures that encourage
integrated service provision
Invest in continuous quality improvement including
publishing the use of outcome data for peer review and
public scrutiny
(Goodwin et al 2011; Rosen et al 2011)
44. What does this experience tell
us about adopting and
mainstreaming integrated care
‘at scale’?
45. The core components of a successful
integrated care strategy (1)
Defined populations that enable health care teams to
develop a relationship over time with a ‘registered’
population or local community, and so to target individuals
who would most benefit from more co-ordinated approach
to the management of their care
Aligned financial incentives that: support providers to
work collaboratively by avoiding any perverse effects of
activity-based payments; promote joint responsibility for
the prudent management of financial resources; and
encourage the management of ill-health in primary care
settings that help prevent admissions and length of stay in
hospitals and nursing homes
46. The core components of a successful
integrated care strategy (2)
shared accountability for performance through the use
of data to improve quality and account to stakeholders
through public reporting
information technology that supports the delivery of
integrated care, especially via the electronic medical record
and the use of clinical decision support systems, and
through the ability to identify and target ‘at risk’ patients
the use of guidelines to promote best practice, support
care co-ordination across care pathways, and reduce
unwarranted variations or gaps in care
47. The core components of a successful
integrated care strategy (3)
A physician–management partnership that links the
clinical skills of health care professionals with the
organisational skills of executives, sometimes bringing
together the skills of purchasers and providers ‘under one
roof’
Effective leadership at all levels with a focus on
continuous quality improvement
A collaborative culture that emphasises team working
and the delivery of highly co-ordinated and patient-centred
care
48. The core components of a successful
integrated care strategy (4)
Multispecialty groups of health and social care
professionals in which, for example, generalists work
alongside specialists to deliver integrated care
Patient and carer engagement in taking decisions about
their own care and support in enabling them to self-care –
‘no decision about me without me’
50. What evidence do we already have?
Research into structures and processes, or specific aspects
of chronic disease management (eg, Shortell 2009)
Evidence that integrate care programmes have a positive
effect on quality (eg, Ouwens et al 2005)
Evidence of high performance by US integrated delivery
systems (eg, Asch et al 2004; Feachem et al 2002)
Some emerging UK and international evidence about
outcomes (eg, Ham and Curry 2010; Rosen et al 2011)
Some emerging UK and international evidence about
efficiency, but more studies needed
51. What evidence do we need?
Impact on patient experience, including the development of
‘markers’ for improved processes of care
Impact on use of services, especially inpatient beds
Impact on costs, and differentially on different parts of the
system
Impact on outcomes, with markers developed
(Ramsay, Fulop and Edwards 2009)
52. Take home messages (1)
Integrated care is best understood as a strategy for
improving patient care
The service user is the organising principle of integrated
care
One form of integrated care does not fit all
Organisational integration is neither necessary nor always
sufficient. Virtual or contractual integration can deliver
many benefits
Clinical or service integration matters most
53. Take home messages (2)
Start by integrating from the bottom up
Develop a systemic framework that aligns incentives so
integrated care locally can be enabled, supported and
driven
Use a range of tools to support integrated care
Undertake evaluation and build in quality improvement - it
is only possible to improve what you measure
Better care experiences, improved care outcomes, delivered
more cost-effectively are the keys by which integrated care
should be judged
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